What I know now that I wish I knew then
Michael Neumeister, MD, is chair of the Department of Surgery and chief of the Division of Plastic Surgery at Southern Illinois University – as well as J. Roland Folse, MD, Endowed Chair; Elvin G. Zook Endowed Chair; and Plastic Surgery Residency Program director.
Dr. Neumeister is also vice president of the American Association of Hand Surgery and editor of its journal, HAND. Past president of The PSF and the American Society of Reconstructive Microsurgery, Dr. Neumeister completed general surgery residency at Dalhousie University in Nova Scotia, Canada, and plastic surgery residency at Manitoba University in Manitoba, Canada. His fellowship training includes hand and microsurgery at Brigham and Women's Hospital and microsurgery at Southern Illinois University.
PSR: What do you enjoy most about being a plastic surgeon?
Dr. Neumeister: Plastic surgery is an incredible specialty. I enjoy the diversity and complexity, as well as the challenges that force us to create new techniques and innovate regularly.
PSR: What do you enjoy least about being a plastic surgeon?
Dr. Neumeister: I wish the average layperson would understand how diverse and comprehensive the field of plastic surgery is.
PSR: What is the hardest year of training?
Dr. Neumeister: It's often the internship year, as one needs to learn surgical techniques, patient care and being a professional – with every rotation being new and, at times, overwhelming.
PSR: What qualities make a good intern, junior resident and senior resident?
Dr. Neumeister: Many of the qualities of a good intern are similar to those of a good junior or senior resident. In fact, the same qualities also can be said of defining good faculty: Honesty, integrity, self-directed, enthusiastic, creative, team player, respectful, eager to learn, empathetic and hard-working. Everyone should read as much as possible. Being inquisitive is also very important.
As an intern, one should seek more information on the principles of surgical care, as well as the basics on the principles of plastic surgery. Interns should practice knot-tying constantly. The proper handling of instruments and various tissues should be practiced repetitively.
The junior resident should try to acquire dexterity techniques and broaden their understanding of 3-D reconstruction and aesthetic principles.
The senior resident should develop the leadership skills that will help them in their practice, and be very observant of attending techniques and decision-making. Teaching junior residents helps the seniors better understand areas of complexity and the efficiency of various procedures.
PSR: If you could repeat residency knowing what you know now, what would you do differently?
Dr. Neumeister: I would try to reduce surgeries to specific soundbites throughout the case. I would then pick a specific point in every surgery to master, until I had a greater level of competence for the entire operation. I would ask my attending to work like a coach to optimize each step in an operation. Many coaches tell their players that they need to work on specific tasks on any one day, breaking down the skills to certain parts of a game. Surgery can be done the same way to make the resident better and more efficient. I would have mentors and coaches that I would lean on throughout my training.
PSR: What's your advice for residents interested in going into academic medicine?
Dr. Neumeister: I'm thrilled when residents want to go into academics. It warms my heart. It would be unreasonable, though, to believe that all residents would or should go into academics, as we need our graduates in communities outside of academics to service in a thorough, competent and passionate manner. If you're seeking academics, a post-graduate fellowship helps bring some added expertise to your new position. Always seek the fellowship that excites you – and work hard to learn as much as you can from your new attendings. It's your year to shine. As fellowships are competitive, increasing your research and teaching portfolio may be important. The earlier one decides on entering academics, the more robust your academic portfolio will become.
PSR: How did you make the most of your fellowship year – and what is your advice for those currently in their fellowship?
Dr. Neumeister: Fellowship year is a short period in your life when you should be trying to push yourself to acquire as much new knowledge and surgical skill as you can. You have chosen to spend extra time to become more specialized, and you should make the most of that year. Be extremely inquisitive and never shy away from the difficult cases. Be a sponge!
PSR: What skill have you learned that you wish you had earlier in your career?
Dr. Neumeister: Time management. Understanding how to be involved in various committees, societies and boards and still be productive in the academic, clinical and teaching arenas in which we reside takes some time to become efficient without incurring stress or the feeling of being overwhelmed.
PSR: How do you become a good teacher in the O.R.?
Dr. Neumeister: Becoming a good teacher in the O.R. can be difficult. We all assume we're good, but as surgical educators we need to adjust our style or teaching techniques to the various levels of learners we have in the room at any one time. Sometimes there are different levels of learners in the same case, so the discussions need to change based on such levels. Asking open-ended questions such as "What if..." helps the resident work through specific situations. Surgical educators should learn to become good coaches so they can help residents get through focused, goal-oriented tasks. This means breaking the surgery into specific components and then taking a deep dive into these tasks. Focus on one or two items to master during the surgery. Trying to ask the resident to become a master surgeon all in one setting is a losing battle. No one asked Wayne Gretzky or me to master hockey all at once – coaching was needed. Most important of all is patience. A good teacher must have patience.
PSR: What’s your favorite case to perform?
Dr. Neumeister: My favorite case is a toe-to-hand surgery – highly technical and highly rewarding. It restores form and function, and it is awesome.
Dr. Ruffolo is PGY-4 at Southern Illinois University.